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PCPs with allopathic training, smaller Medicare panels less likely to provide low value care

Researchers identified specific characteristics of primary care physicians that were associated with providing unnecessary medical services, or low value care, to patients, according to a study published in the Journal of the American Board of Family Medicine.

“It is important to assess and understand low value care services particularly in the setting of increasingly greater health care costs,” Tyler W. Barreto, MD, of the Robert Graham Center in Washington, D.C., and the department of family and community medicine at the University of Texas Health San Antonio, and colleagues wrote. “Past studies have identified regional and patient characteristics and clinic settings associated with low value care, but no study to our knowledge has focused on individual physician characteristics.”

To assess the association between primary care physician characteristics and low value care spending, researchers conducted a retrospective analysis of 6,873 primary care physicians (mean age, 51 years; 27% women) with 1,078,840 attributable patients who were aged 65 years or older. Medicare claims data were used to identify low value care and the AMA Masterfile was used to identify primary care physician characteristics.

Researchers then measured Medicare spending per attributed patient on eight low value services including low back pain imaging in the first 6 weeks of diagnosis, brain imaging for simple syncope, screening for osteoporosis in men younger than 70 years, cardiac screening for low-risk asymptomatic patients, prostate cancer screening, routine preoperative testing for low-risk surgical procedures, carotid artery disease screening and cervical cancer screening for women aged 65 and older.

Researchers found that primary care physicians who had allopathic training and a smaller Medicare patient panel, those who practiced family medicine and who practiced in the Midwest region or rural areas and those who were recent graduates had lower per-patient low value care Medicare spending.

While the average per-patient spending was $14.67, low value care spending among primary care physicians with small patient panels was $3.89 less per patient than those with larger panels.

Finally, researchers observed that primary care physicians in the Midwest had $2.80 less per-patient low value care spending than those in the Northeast.

“Future studies should further characterize physicians with fewer low value care services and might consider other potential factors, such as scope of practice and role of primary care,” the researchers wrote. “By understanding characteristics associated with less low value care, we can begin to strategize on ways to decrease medical waste in the United States.” – by Melissa J. Webb

Disclosures: The authors report no relevant financial disclosures.